Rh


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Rh o (D) Immune Globulin IV (Human)
Rh o (D) Immune Globulin IV (Human) WinRho
Rh o (D) Immune Globulin IV (Human)
(roh (dee) im- MYOUN GLOH-byou-lin)
Pregnancy Category: C WinRho SD WinRho SDF (Rx)

Classification: Immunosuppressant

Action/Kinetics: Sterile, freeze-dried gamma globulin (IgG) fraction containing antibodies to Rh o (D) derived from human plasma. The manufacturing process is effective in inactivating lipid-enveloped viruses, including hepatitis B and C and HIV. Contains approximately 2 mcg IgA/1,500 international units (300 mcg). It suppresses the immune response of nonsensitized Rh o (D) antigen-negative individuals following Rh o (D) antigen-positive red blood cell exposure. Mechanism is unknown. Suppression of Rh isoimmunization decreases the possibility of hemolytic disease in an Rh o (D) antigen-positive fetus in present and future pregnancies. Peak levels, after IV: 2 hr; after IM: 5-10 days. t 1/2, after IV: 24 days; after IM: 30 days.

Uses: Suppression of Rh isoimmunization in non-sensitized Rh o (D) antigen-negative women within 72 hr after spontaneous or induced abortions, amniocentesis, chorionic vilus sampling, ruptured tubal pregnancy, abdominal trauma, transplacental hemorrhage, or in the normal course of pregnancy unless the blood type of the fetus or father is known to be Rh o (D) antigen-negative. Suppression of Rh isoimmunization in Rh o (D) antigen-negative female children and female adults in their childbearing years transfused with Rh o (D) antigen-positive RBCs or blood components containing Rh o (D) antigen-positive RBCs. Treatment of non-splenectomized Rh o (D) antigen-positive children with chronic or acute immune thrombocytopenic purpura (ITP), adults with chronic ITP, or children and adults with ITP secondary to HIV infection in clinical situations requiring an increase in platelet count to prevent excessive hemorrhage.

Contraindications: History of anaphylactic or severe systemic reaction to human globulin (i.e., due to the presence of trace amounts of IgA). Administration to Rh o (D) antigen-negative or splenectomized individuals, as efficacy has not been shown. Use in Rh o (D) antigen-negative clients who are Rh immunized (Rh antibody-positive), as evidenced by standard manual Rh antibody screening tests. Use in infants.

Special Concerns: Use with extreme caution in those with a hemoglobin level less than 8 g/dL due to the possibility of increasing the severity of anemia.

Side Effects: When used for Rh isoimmunization suppression. Side effects are infrequent but include discomfort and slight swelling at the injection site and a slight elevation in temperature. There is the possibility of anaphylaxis.
When used for ITP. Most commonly, headaches, chills, and fever. Decreased hemoglobin.

How Supplied: Powder for injection: 600 IU; 1,500 IU; 5,000 IU

Dosage
?IM, IV. Pregnancy.
1,500 IU (300 mcg) at 28 weeks gestation. If given early in the pregnancy, administer at 12-week intervals in order to maintain an adequate level of passively acquired anti-Rh (antibodies). Give 600 IU (120 mcg) to the mother as soon as possible after delivery of a confirmed Rh o (D) antigen-positive baby and within 72 hr after delivery. If the Rh status of the baby is not known at 72 hr, give the drug to the mother. If more than 72 hr have elapsed, do not withhold the drug but give as soon as possible up to 28 days after delivery.
Other obstetric conditions.
600 IU (120 mcg) immediately after abortion, amniocentesis (after 24 weeks gestation), or any other manipulation late in pregnancy (after 34 weeks gestation) associated with an increased risk of Rh isoimmunization. Give 1,500 IU (300 mcg) immediately after amniocentesis before 34 weeks gestation or after chorionic vilus sampling. Repeat this dose q 12 weeks during pregnancy. Give as soon as possible in the event of threatened abortion.
Incompatible blood transfusions or massive fetal hemorrhage.
IV: 3,000 IU (600 mcg) q 8 hr until the total dose is given. IM: 6,000 IU (1,200 mcg) q 12 hr until the total dose is given.
?IV only ITP.
Initial: 250 IU (50 mcg)/kg (125-200 IU/kg if the hemoglobin level is less than 10 g/dL). Give the initial dose as a single dose or two divided doses on separate days. If subsequent therapy is required, give 125-300 IU (25-60 mcg)/kg by IV only.

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